Nonsteroidal anti-inflammatory drugs, often referred to as NSAIDS, are assumed to be well tolerated and are widely used as a therapy for common inflammation. Everyone is familiar with these types of drugs with millions using them for pain relief. They range from over the counter aspirin and ibuprofen to a whole host of prescription brands. These pharmaceuticals constitute one of the most widely used class of drugs in the world.

NSAIDs are often called nonsteroidal because they are not steroids. Steroids affect inflammation by suppressing part of the immune system, which is the body's natural healing response to trauma. Instead NSAID drugs mainly inhibit the body's ability to synthesize prostaglandins. Prostaglandins are a family of hormone-like chemicals, some of which are made in response to cell injury.

The July 1998 issue of The American Journal of Medicine stated the following:

"Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated."

And again a year later (June 1999) in the prestigious New England Journal of Medicine there is a similar statement:

"It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States. This figure is similar to the number of deaths from the acquired immunodeficiency syndrome and considerably greater than the number of deaths from multiple myeloma, asthma, cervical cancer, or Hodgkin's disease. If deaths from gastrointestinal toxic effects from NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain mainly a "silent epidemic," with many physicians and most patients unaware of the magnitude of the problem. Furthermore the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDS."

A recent study in Therapeutics and Clinical Risk Management notes that shockingly the number of deaths and hospitalizations from GI bleeding due to NSAIDs has remained unchanged since that 1999 study.

"Major adverse gastrointestinal events attributed to NSAIDs are responsible for over 100,000 hospitalizations, US $2 billion in healthcare costs, and 17,000 deaths in the US each year. Despite improvements in the available medications to aid in healing and treatment of NSAID-associated complications, the number of hospitalizations and deaths has remained unchanged in the US in the last decade."

The dangers of NSAIDs were known even before that 1999 article. In 1991 in the Journal of Rheumatology the authors estimate a large number of deaths each year attributed to NSAID use.

"Overall death estimates are similarly disquieting. Conservative calculations, counting only excess deaths, indicate that about 7,600 deaths/year in the United States are attributable to NSAID use. The Food and Drug Administration suggests even higher figures, estimating NSAID use accounts for 10,000 to 20,000 deaths/year. These figures are comparable to Hodgkin's disease or acquired immunodeficiency syndrome and represent a serious problem."

Since this devastating problem is apparently not being tracked by anyone in any governmental agency or medical organization it isn't possible to know the exact number of deaths and hospitalizations. However, if we use the studies quoted and make conservative assumptions, such as using the lower figure of 7,600 from that 1991 study, we can create a table that shows the enormous problem of GI bleeding from NSAIDS.

Performing these calculations the numbers are simply beyond imagination. If these studies are correct then approximately 300,000 people have died from GI complications due to NSAIDs with almost 1,700,000 people being hospitalized at a cost of $38.8 billion. Again it's important to note that these figures are considered conservative and do not include over the counter medications or prescriptions for other conditions other than arthritis.

Putting these numbers into perspective the number of people killed from NSAID GI bleeding at 300,000 is greater than the number of dead at 234,000 from the Revolutionary War, War of 1812, Mexican War, Spanish-American War, World War I, Korean War, Vietnam War, and Persian Gulf War combined. The number of people hospitalized due to NSAID bleeding actually is higher at 1.7 million than the American casualties from all American wars combined at a total of 1.4 million.

These numbers are beyond shocking. If the 16,500 number of deaths and 107,000 hospitalizations from NSAID internal bleeding are correct then each day 45 people die and 293 are hospitalized in the United States alone. Looking at other countries we have a limited amount of information such as 4,000 deaths in Great Britain and 1,650 deaths in Germany so the true extent of the number of deaths and hospitalizations worldwide is not known. With sales increasing globally the problem will only grow. A December 2009 article shows that the use of these medications is continuing to grow.

"There are scores of people in the country, who, like Mohan, pop painkillers indiscriminately, not so much on prescription as out of habit. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, ketoprofen, naproxen and diclofenac are commonly taken, helped by the fact that these drugs are sold over the counter (OTC). The US Food & Drugs Administration has issued strong warnings against irrational use of these drugs, saying it can increase risks of liver damage and stomach bleeding. Still, NSAIDs are growing at a whopping 20% annually in India, well over the 14% overall growth rate for the local pharmaceutical industry."

These facts are appalling and do not even include other negative effects of NSAIDs such as increased heart attacks that have caused even more hospitalizations and deaths than appear in these numbers.

"In this study we found that recent use of NSAIDs by elderly patients doubles the odds of being admitted to hospital with an episode of CHF [Congestive Heart Failure]. The estimated relative risk for first admission with heart failure, and the risk of this outcome was increased substantially by NSAID use in those with a history of heart disease. ... Assuming the association between use of NSAIDs and CHF is unconfounded, the disease burden attributable to these drugs may be large - approaching the levels of morbidity and mortality that we have previously documented for serious upper gastrointestinal complications of NSAID use in NSW [New South Wales]."

A study by FDA researcher David Graham estimated that "27,000 heart attacks or sudden cardiac deaths nationwide from the time it [Vioxx] came on the market in 1999 through 2003."

NSAIDs are truly a silent epidemic that have caused a tremendous amount of pain and death. Public knowledge of this tragedy is virtually non-existent with a large amount of information written on this topic primarily existing within the sanctuary of medical libraries. Pharmaceutical companies still market and promote worldwide sales of these toxic substances and governmental agencies have done nothing of any substance to alert the public to this problem. With very few people paying attention to this massive crisis the deaths and hospitalizations will continue.